Feasibility of HISA During TURBT for NMIBC

A Pilot Study Using Hyperthermic Irrigation Followed by Intravesical Chemotherapy in Patients With Low- to Intermediate-Risk Non-Muscle Invasive Bladder Cancer

The goal of this prospective pilot study is to evaluate the safety and feasibility of using heated saline during bladder tumor surgery in patients with non-muscle invasive bladder cancer.

The main questions it aims to answer are:

Can heated saline be given during bladder tumor removal surgery safely?

Does using heated saline keep the bladder tumor from coming back?

Researchers will compare the heated saline to room temperature saline to see if the heated saline works to prevent the bladder tumor from coming back.

Participants will:

• Have heated saline or room temperature saline during bladder tumor surgery
• Visit the clinic at 2 weeks, 3 and 6 months after bladder tumor surgery
• Complete questionnaires about quality of their life and symptoms before and after surgery
• Provide urine samples to test your urine at each visit before and after surgery
• To have a cystoscopy to check your bladder for tumors

Study Overview

• Status: Not yet recruiting
• Conditions: Bladder Cancer; Non-muscle Invasive Bladder Cancer; Transurethral Resection of the Bladder; Non-muscle Invasive Bladder Cancer (NMIBC); Transurethral Resection of Bladdertumors; Bladder (Urothelial, Transitional Cell) Cancer Resectable (Pre-Cystectomy); Non-Muscle Invasive Bladder Neoplasms; Non-Muscle Invasive Bladder Carcinoma; Bladder Cancer (BC)
• Intervention / Treatment: Device: HISA

Detailed Description

Non-muscle invasive bladder cancer (NMIBC) represents 75% of bladder cancer cases and recurs in up to 79% of patients. West Virginia carries disproportionately high bladder cancer incidence due to smoking, aging population, and occupational exposures. High recurrence requires frequent cystoscopy and intravesical therapy, creating a burden for rural Appalachian patients. New strategies to reduce recurrence and treatment are urgently needed.

Hyperthermic intravesical chemotherapy improves drug penetration and tumor cell sensitivity. However, the benefit of applying hyperthermic saline intraoperatively during resection of the bladder tumor is unknown. In this randomized, two-arm study, we will randomize 40 patients with low-risk appearing NMIBC to normothermic and hyperthermic saline irrigation during bladder tumor resection. Hyperthermic irrigation will be delivered at 42 ± 2° Celsius using the Stryker Thermaclear FluidSmart system. All patients will receive standard postoperative gemcitabine instillation. Follow-up visits will occur at 2 weeks, 3 and 6 months. The primary goal is feasibility, defined as 80% protocol adherence to hyperthermic irrigation. Secondary goals include safety, logistics, and patient retention. Additional outcomes include recurrence, adverse events, and patient-reported quality-of-life scores.

• Study Type: Interventional
• Enrollment (Estimated): 40
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Michael G Stencel, DO; Phone Number: 1-304-388-5280; Email: michael.stencel@vandaliahealth.org
• Study Contact Backup: Name: Jacqueline C Fannin, PhD; Phone Number: 1-304-388-9923; Email: jacqueline.fannin@vandaliahealth.org

Study Locations

• United States
  • West Virginia
    • Charleston, West Virginia, United States, 25304
      • Charleston Area Medical Center Memorial Hospital
      • Contact: Jacqueline C Fannin, PhD; Phone Number: 6062250344; Email: jacqueline.fannin@vandaliahealth.org
      • Contact: Email: jacqueline.fannin@vandaliahealth.org
      • Principal Investigator: Michael G Stencel, DO
      • Sub-Investigator: Jacqueline C Fannin, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Male or female patients
• Age from 18 to 89 years old
• Visual diagnosis of a papillary tumor(s) ≤ 3 cm
• Transurethral resection of bladder tumor (TURBT)
• Eastern Cooperative Oncology Group (ECOG) performance status grade 0-2
• Glomerular filtration rate (GFR) ≥ 30 mL/min

Exclusion Criteria:

• Ages less than 18 years of age
• Pregnant women
• Prisoners
• Patients with evidence of distant metastasis
• Patients with histologically confirmed high-risk NMIBC prior to and after TURBT
• Patients with prior carcinoma is situ diagnosis
• Patients with an active infection defined as documented urinary tract infection based on preoperative urine analysis or urine culture
• Immunosuppression defined as a patient with leukopenia or taking any active immunosuppressive medication
• Patients that had an intraoperative perforation during TURBT
• Patients participating in another clinical trial with this urologic cancer diagnosis
• Postoperative bladder instillation failure defined as the inability to deliver and maintain the planned volume of instilled fluid within the bladder for at least 30 minutes

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: No HISA; The control arm (no HISA) will consist of standard intraoperative care including bladder irrigation with normothermic saline during TURBT.
Experimental: HISA; The intervention arm (HISA) will be treated in the same way as the control arm with the addition of administering hyperthermic (42.0 ± 2°C) intravesical saline during the TURBT.	Device: HISA; The intervention arm (HISA) will be treated in the same way as the control arm with the addition of administering hyperthermic (42.0 ± 2°C) intravesical saline during the TURBT. Bladder irrigation with 1g of gemcitabine will be delivered in the immediate postoperative setting. The Thermaclear FluidSmart Fluid management system (Stryker, MI) will be used to administer and irrigate the bladder with normothermic or hyperthermic intravesical saline during the TURBT.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Patient Recruitment	The primary outcome will be patient recruitment. Patient recruitment will be the number of patients recruited divided by the total number of eligible patients.	one year
Protocol Adherence for HISA Treatment	Protocol adherence will be assessed per case. Full adherence is defined as: (1) assigned saline used; (2) temperature maintained at 42.0 ± 2.0°C for ≥80% of intended exposure; (3) delivery of hyperthermic saline occurred during the specified operative window, and (4) postoperative instillation of 1g gemcitabine for 60 minutes.	one year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of HISA Treatment-related Complicatons, Adverse Events, and Readmission Rates	To assess postoperative complications, adverse events, and readmission rates at 30- and 90-days. Adverse events will be monitored during the study for up to 90 days for each patient, assessed and graded using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.	Three years

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Overall Cancer-related Quality of Life and General Treatment Effects	Quality of life will be assessed at the preoperative visit and follow-up visits at 2-weeks, 3 months, and 6 months using the EORTC QLQ Core Questionnaire (EORTC QLQ-C30, version 3.0).	From TURBT to 6 months after TURBT
Recurrence of NMIBC	The proportion of patients with recurrence of NMIBC will be determined. Recurrence will be defined as the percentage of patients with the reappearance of NMIBC tumor(s) within the bladder following transurethral resection of bladder tumor (TURBT). The event will be defined as the earliest date of recurrence as determined using the date of cystoscopy, biopsy, or cytology, whichever occurs first.	From time of TURBT to 6 months after TURBT
Survival of NMIBC Patients	Survival will be defined as the percentage of patients who have survived after TURBT without any recurrence or death from any cause. The event will be defined as the length of time until cancer recurrence or death from any cause using the date of cystoscopy, biopsy, or death certificate date whichever occurs first.	From time of TURBT to 6 months after TURBT
Patient Quality of Life Concerns and Symptoms of HISA Treatment of NMIBC	Quality of life will be assessed at the preoperative visit and follow-up visits at 2weeks, 3 months, and 6 months using the EORTC QLQ-NMIBC 24.	From TURBT to 6 months after TURBT

Collaborators and Investigators

• Sponsor: CAMC Health System
• Collaborators: West Virginia Clinical and Translational Science Institute
• Investigators: Principal Investigator: Michael G Stencel, DO, CAMC Health System

Study record dates

Study Major Dates

• Study Start (Estimated): August 15, 2026
• Primary Completion (Estimated): February 29, 2028
• Study Completion (Estimated): May 31, 2030

Study Registration Dates

• First Submitted: July 9, 2026
• First Submitted That Met QC Criteria: September 8, 2026
• First Posted (Actual): September 14, 2026

Study Record Updates

• Last Update Posted (Actual): September 14, 2026
• Last Update Submitted That Met QC Criteria: September 8, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Urogenital Neoplasms; Neoplasms by Site; Neoplasms; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Neoplasms by Histologic Type; Neoplasms, Glandular and Epithelial; Urologic Neoplasms; Carcinoma; Urinary Bladder Diseases; Non-Muscle Invasive Bladder Neoplasms; Urinary Bladder Neoplasms
• Other Study ID Numbers: 25-1357; U54GM104942 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared to protect patient privacy and confidentiality. The study includes sensitive health information, and even when data are de-identified, there is a small risk that participants could be identified. In addition, there are no current plans or resources to support data sharing agreements or external data requests. Summary results will be reported in publications instead.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: Yes